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Non-routine Discharge From Military Service: Mental Illness, Substance Use Disorders, and Suicidality

  • Emily Brignone
    Affiliations
    Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah

    Department of Psychology, Utah State University, Logan, Utah
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  • Jamison D. Fargo
    Affiliations
    Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah

    Department of Psychology, Utah State University, Logan, Utah

    National Center for Homelessness Among Veterans, VA Medical Center, Philadelphia, Pennsylvania;
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  • Rebecca K. Blais
    Affiliations
    Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah

    Department of Psychology, Utah State University, Logan, Utah
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  • Marjorie E. Carter
    Affiliations
    Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah

    Departments of Internal Medicine and Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah
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  • Matthew H. Samore
    Affiliations
    Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah

    Departments of Internal Medicine and Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah
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  • Adi V. Gundlapalli
    Correspondence
    Address correspondence to: Adi V. Gundlapalli, MD, PhD, MS, Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System, 500 Foothill Drive, Mail Stop 182, Salt Lake City UT 84148
    Affiliations
    Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah

    National Center for Homelessness Among Veterans, VA Medical Center, Philadelphia, Pennsylvania;

    Departments of Internal Medicine and Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah
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Published:January 18, 2017DOI:https://doi.org/10.1016/j.amepre.2016.11.015

      Introduction

      Mental illness and substance use disorders among newly returned military service members pose challenges to successful reintegration into civilian life and, in extreme cases, may lead to outcomes such as incarceration, homelessness, and suicide. One potential early indicator for these difficulties is non-routine discharge from military service.

      Methods

      Using data from the Veterans Health Administration (VHA) for 443,360 active duty service Veterans who deployed to Afghanistan and Iraq and subsequently utilized VHA services between Fiscal Years 2004 and 2013, this study examined risk for receiving a VHA-documented diagnosis of mental illness, substance use disorders, and suicidality as a function of discharge type, controlling for demographic and military service covariates. Analyses were conducted in 2016.

      Results

      In total, 126,314 Veterans (28.5%) had a non-routine military service discharge. Compared with routinely discharged Veterans, odds for nearly all diagnostic outcomes were significantly greater among Veterans discharged for disqualification or misconduct, including personality disorders (AOR=9.21 and 3.29, respectively); bipolar/psychotic disorders (AOR=3.98 and 3.40); alcohol/substance use disorders (AOR=1.55 and 4.42); and suicidal ideation and behaviors (AOR=2.81 and 2.77). Disability-discharged Veterans had significantly higher odds for diagnoses of anxiety disorders (AOR=1.97) and bipolar/psychotic disorders (AOR=3.93).

      Conclusions

      Non-routine service discharge strongly predicts VHA-diagnosed mental illness, substance use disorders, and suicidality, with particularly elevated risk among Veterans discharged for disqualification or misconduct. Results emphasize the importance of discharge type as an early marker of adverse post-discharge outcomes, and suggest a need for targeted prevention and intervention efforts to improve reintegration outcomes among this vulnerable subpopulation.
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      Linked Article

      • Veterans and the National Tragedy of Suicide
        American Journal of Preventive MedicineVol. 53Issue 4
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          A recent publication in the American Journal of Preventive Medicine by Brignone et al.1 has highlighted that Veterans receiving non-routine discharges are at risk for homelessness, incarceration, and suicide. The publication, “Non-routine Discharge From Military Service: Mental Illness, Substance Use Disorders, and Suicidality,” focused on this vulnerable population often facing significant challenges when reintegrating into civilian life.
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